Ingrown Nails

Ingrown toenails are common, with the big toe most likely to be affected on one, or sometimes, on both sides. The toenail curves and grows into the skin next to the nail, causing the toe to become tender and painful, particularly when you walk on it.

What are the most common problems with ingrown nails?

Ingrown toenails can become red, swollen and/or tender causing a lot of discomfort and can be aggravated by light touch and may hurt in bed or in footwear. If not addressed, ingrown toenails may lead to an infection.

How do these problems arise?

Excessive sweating – If the skin on your toes and feet is warm and moist, you are more likely to develop an ingrown toenail as the soft skin is easily pierced by the nail edge.

Injury – such as stubbing the toe, dropping something on it, or even wearing tight fitting shoes, can cause also an ingrowing toenail to develop.

Genetic factors – your risk of developing an ingrown nail can be increased by genetic factors, such as the way you stand and walk, or if you have a naturally curved, or fan-shaped toenail.

Poorly cut toenails – this can leave a sharp edge which is able to grow into the skin, causing an ingrown nail

How can they be treated?

It is best to treat an ingrown toenail as soon as you notice the symptoms. If caught early enough, your podiatrist may recommend the self-care advice listed below to prevent it from getting worse.

Soak your foot in warm water 3-4 times a day and use a cotton bud to gently push the skin away from your toenail.

Wear comfortable shoes with enough space around your toes.

When should they be checked by a podiatrist and how can Total Care Podiatry help you?

If your symptoms persist, your podiatrist will be able to remove the small part of the nail that is digging into your skin.

If your nail is infected, you may need to be prescribed a course of antibiotics.

Surgery may be required when an ingrown toenail repeatedly gets infected, is continually painful, when you are unable to wear shoes or the condition inhibits work, sporting or other activities.

Before surgery is recommended, your podiatrist will explore other, more conservative treatment options.

WARNING

This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

Paul Graham has been using plantar pressure analysis as part of his clinical practice since first purchasing an Fscan Mat and in-shoe system in 1998. It was a steep learning curve to understand the information behind the pretty colours and what it means. This form of analysis was in its infancy in Australia, and the only way of gaining an appreciable understanding of what the data represented and how could be used in clinical practice was gained through regular email and phone contact with a number of American podiatrists who had been using the Fscan system for many years.

The most well-known of these practitioners is Dr Howard Dannenberg and through this relationship Paul grew to understand the relationship of sagittal plane movement and the importance of how the foot has a significant effect on the rest of the body. In fact Paul’s foundational knowledge of recording, data management and analysis came through Howard’s leadership and the plantar pressure case studies that were shared. This knowledge base was further augmented when Dr Bruce Williams DPM, a protégé of Howard’s training, visited Australia in 2004 and stayed with Paul in Geelong, working and training him in his clinic. In 2005, Paul was invited to Latrobe University to present on his clinical use of plantar pressure in the prescription of the orthotic correction design.

Up until this stage, Paul was combining evidence-based examination and video gait assessment with plantar pressure analysis and, through this orthotic manufacture. The issue was that each part of the assessment used different equipment. In 2006 Paul moved to the Milletrex system, (forerunner of the Freestep software and Sensormedica hardware) and as this combined all aspects of the diagnostic and manufacturing process, he moved to this system. Again a learning curve was required to become familiar with the different parts of the system, however planter pressure is planter pressure and as such, once you understand the recording and data management side, analysis can be done.

In late 2010, the Freestep software program was presented and the engineers in Italy were keen to make it the best on the market. Through the years there have been regular updates making the program more user-friendly and the data presentation more valuable and easy to understand. In fact at present Paul is working with Scott Sorenson and the Italian software developers to enhance this further so that areas of dysfunction and asymmetry are easily noted and measured,. This will be valuable for both the initial assessment and also to easily chart improvement at review appointments. This continued refinement and development, makes Freestep a very valuable clinical tool.

Plantar pressure analysis can only grow in significance as it shows objective data that the eye cannot see. This is now even more important with the discovery that vertical force,( that we describe as pressure), is what causes the overloading that results in tissue damage, rather than any angular anomaly such as an inverted heel or lowering of the medial longitudinal arch. Using Freestep enables Paul to chart improvement effectively and efficiently each visit by simply having a person walk over the mat or treadmill and comparing it to the previous visit; all within five minutes. This is then a record of the patient’s progress, valuable, not only to the treating clinician, but also to any third party who is paying for the treatment.

Video gait assessment is very, very helpful in understanding the biomechanics of the body in motion and should be used in conjunction with planter pressure analysis; however Paul’s clinical use of plantar pressure analysis has led him to the conclusion that it is superior in consistency, ease and speed.